Long‐Term Mechanical Circulatory Support in Pediatric Patients

Abstract

This retrospective study reviews our results regarding the long-term support in pediatric patients using two ventricular assist systems between January 2008 and April 2014. We implanted the Berlin Heart EXCOR in 29 patients (median age 3.4 years [interquartile range (IQR) 0.2-16.5], median weight 13 kg [IQR 4.2-67.2]). Twenty-two patients (75.8%) received a left ventricular assist device. Three patients (10.3%) had single-ventricle physiology. One patient (3.4%) had mechanical mitral valve prosthesis. The HeartWare System was implanted in nine patients. The median age was 15.6 years (IQR 12.2-17.9), and the median weight was 54.9 kg (IQR 27.7-66). In the Berlin Heart group, the median support time was 65 days (IQR 4-619), with 3647 days of cardiac support. Nineteen patients (65.5%) were transplanted, six patients (20.7%) recovered, one patient (3.4%) is on support, and three patients (10.3%) died on support. Survival rate was 89.7%. Fourteen blood pumps had been exchanged. Four patients (13.8%) had local signs of infection, and three patients (10.3%) had neurological complications. In the HeartWare group, the median support time was 180 days (IQR 1-1124), with 2839 days of cardiac support. Four patients (44.4%) had local signs of infection, and three (33.3%) had neurological complications. Eight patients (88.9%) have been transplanted, and one patient (11.1%) died on support. Survival rate was 88.9%. Excellent survival is possible after long-term mechanical circulatory support in patients with two- and single-ventricle physiology with a low rate of adverse events.

The Use of Berlin Heart EXCOR VAD in Children Less than 10 kg: A Single Center Experience

“…However, because of the lack of organ donors, especially in very small children, the use of ventricular assist device (VAD) is a validated therapy to bridge patients to the OHTx with a success rate up to 84% (Ibrahim et al, 2000; Reinhartz et al, 2003; Chang and McKenzie, 2005; Stiller et al, 2005; Hetzer et al, 2006; Gandhi et al, 2008; Brancaccio et al, 2010, 2013; Potapov et al, 2011; Almond et al, 2013; Miera et al, 2014; Kirklin, 2015; Mascio, 2015; Sandica et al, 2016). …”

Challenges in pediatric mechanical circulatory support devices

“…Heart failure is a primary contributor to global cardiovascular mortality, affecting about 23 million people, 1 and its prevalence is rapidly rising. Among these devices, the EXCOR VAD is the only VAD available to provide long-term support for small children awaiting heart transplantation, 5 and there is no VAD that can be used for destination therapy. 2 The most recent report on HeartMate 3 (Abbott, Abbott Park, IL, USA) showed an actuarial survival of 82.8% at 2 years, 3 which is equivalent to that of patients undergoing heart transplantation.…”

“…A percutaneous MCS device (Impella, Abiomed, Inc., Danvers, MA, USA) has also been used. Among these devices, the EXCOR VAD is the only VAD available to provide long-term support for small children awaiting heart transplantation, 5 and there is no VAD that can be used for destination therapy. Several implantable, continuous-flow VADs developed for adult patients such as HVAD (Medtronic, Minneapolis, MN; formerly HeartWare, Framingham, MA, USA), 6 HeartMate II (Abbott), 7 and HeartMate 3 8 have been used off-label to support larger children and adolescents to transplantation.…”

Mechanical Circulatory Support for Single Ventricle Failure

“…Alternatively, the use of an implantable continuous-flow VAD, such as the HVAD Heartware or Heartmate II, may represent a more suitable option due to the ability for discharge to home(37, 38). Regardless of the type of VAD employed, severe hypoxemia related to veno-venous collaterals remains a challenge during VAD support.…”

“…In the group described by Weinstein and colleagues, 5 patients with Fontan circulation were supported with BHE as a UVAD and 3 survived to transplantation (27). Sandica et al and Hoganson et al published 3 cases of Fontan failure supported with a UVAD BHE and successfully transplanted (37, 45). Nathan et al reported the placement of a BiVAD BHE in a child with failing Fontan circulation as a bridge to transplantation (46).…”